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    <title>入汕人员信息登记</title>
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        <div class="pad24 colorR font34 bold line15">为了您和他人的健康，请对您所填写的资料的真实性、准确性负责。</div>
        <ul class="fillList borderB">
            <li class="fillItem">
                <span class="colorB font28">基本信息</span>
            </li>
            <li class="fillItem">
                <span class="itemName font28">姓名</span>
                <input class="itemValue font28" placeholder="请输入您的姓名"  value="">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">性别</span>
                <select class="itemSelect font28">
                    <option value="1">男</option>
                    <option value="2">女</option>
                </select>
            </li>
            <li class="fillItem">
                <span class="itemName font28">身份证号</span>
                <input class="itemValue font28" placeholder="请输入您的身份证号码"  value="">
            </li>
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                <span class="itemName font28">手机号码</span>
                <input class="itemValue font28" placeholder="请输入您的手机号码"  value="">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">入汕方式</span>
                <select class="itemSelect font28">
                    <option value="火车">火车</option>
                    <option value="高铁">高铁</option>
                </select>
            </li>
            <li class="fillItem">
                <span class="itemName font28">车次</span>
                <input class="itemValue font28" placeholder="请输入入汕火车车次"  value="">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">来源地</span>
                <input class="itemValue font28" placeholder="请选择"  value="">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">目的地</span>
                <input class="itemValue font28" placeholder="请选择"  value="">
            </li>
            <li class="fillItem">
                <span class="colorB font28">个人情况（14天内）</span>
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">当前是否有发烧或咳嗽等症状</span>
                <input class="itemValue font28" placeholder="请选择"  value="否">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">14天内是否经过湖北</span>
                <input class="itemValue font28" placeholder="请选择"  value="否">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">14天内是否经过温州</span>
                <input class="itemValue font28" placeholder="请选择"  value="否">
            </li>
            <li class="fillItem arrow">
                <span class="itemName font28">14天内是否与确诊患者接触</span>
                <input class="itemValue font28" placeholder="请选择"  value="否">
            </li>
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                <span class="check_circle checkOn" style="height: 1.2rem;"></span>
                <span class=" colorR font34 bold line15">上述填写内容真实完整。如有不实,本人愿承担法律责任。</span>
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